De Quervain's tenosynovitis as an occupational disease in agricultural worker: A case report.

BACKGROUND: De Quervain's tenosynovitis is upper-limb disorder, more frequent in women. It is rarely recognized as an occupational disease. OBJECTIVE: In this paper we reported work related de Quervain's tenosynovitis in cow milker. METHODS: Ergonomic risk factors were assessed by utilizing assessment of repetitive tasks (ART) of the upper limbs method. Physical examination and imaging exams were used. RESULTS: We presented a 36-year-old female agricultural worker (workplace cow milker) exposed to work factors (forceful hand/wrist exertions, repetition, extreme postures) for 14 years. She was suffering the pain in the right hand, mainly near the thumb for few years. She was treated conservatively and surgically, however disability was permanent. Clinical examination showed slight edema of the right hand, increased palm's sweating. Patient had reduced range of movements and grip strength. CONCLUSIONS: Report shows that work-related factors were strongly associated with diagnosed de Quervain's tenosynovitis. Hand function plays an essential role in carrying out activities of daily living and this disorder pose a relevant burden of disease. Exposure to biomechanical factors should be an important initial target for the prevention of De Quervain's tenosynovitis in the working population.

Factors Affecting Balance Performance in Adolescents.

(1) Background: The influence of different factors on balance in adolescence is assessed by conducting functional balance tests that examine its different components. (2) Materials and methods: The study sample comprised 110 healthy adolescents of both sexes, aged 12-18 years. Single Leg Stance with Eyes Open (SLS-EO) and Eyes Closed (SLS-EC) tests were conducted to evaluate static balance, whereas the Functional Reach Test (FRT) and Lateral Reach Test (LRT) were performed to establish functional stability limits. The influence of sex, age, demographic factors, anthropometric characteristics, participation in sports activities, and trunk extensor muscle endurance (Biering-Sorensen test) on balance performance was determined through correlational and univariate linear regression analyses. (3) Results: Older age (Beta [ß] = 0.247; 95% CI [0.75, 5.20]; p < 0.01) and better trunk extensor muscle endurance (ß = 0.224; 95% CI [0.015, 0.13]; p < 0.05) were significant predictors of the SLS-EO results, while younger age (ß = -0.219; 95% CI [-1.32, -0.11]; p < 0.05) and higher muscle percentage (ß = 0.237; 95% CI [0.06, 0.48]; p < 0.05) emerged as significant predictors of LRT performance, and greater bone mass was a significant predictor of FRT results (ß = 0.444; 95% CI [3.62, 8.17]; p < 0.01). However, none of the independent variables was a statistically significant predictor of the SLS-EC results. (4) Conclusions: The current study found that age, trunk extensor muscle endurance, muscle percentage, and bone mass are significant predictors of different balance components, suggesting that balance is task-specific.

Cross-cultural validation of the Lower Extremity Functional Scale in Serbian postmenopausal women with knee osteoarthritis.

OBJECTIVE: Translation and cross-cultural validation of the Serbian version of the Lower Extremity Functional Scale (Srb-LEFS). METHODS: This prospective cross-sectional study initially included 186 postmenopausal women aged 60 to 75 years who underwent an x-ray examination of both knees, along with body mass, body height, waist circumference, knee range of motion, and blood pressure measurements. The laboratory analyses included the evaluation of fasting glucose levels and lipid profile. All participants completed the LEFS, Lequesne index, and 36-Item Short-Form Survey-RAND. RESULTS: The analyses revealed good internal consistency (α = 0.95), good test-retest reliability, and a two-factor structure of the Srb-LEFS. Concurrent validity analysis confirmed a significant positive correlation between Srb-LEFS scores and the 36-Item Short-Form Survey-RAND Physical Functioning subscale ( r = 0.889, P < 0.0001), the Lequesne index ( r = -0.976, P < 0.0001), and the Numeric Rating Scale for pain ( r = -0.762, P < 0.0001). Convergent validity analyses revealed a statistically significant negative correlation between the Srb-LEFS scores and age ( r = -0.25, P = 0.006), body mass index ( r = -0.31, P < 0.01), and waist circumference ( r = -0.37, P < 0.0001). The Srb-LEFS scores were statistically significantly higher among participants that reported moderate physical activity levels, as well as those that had fewer comorbidities, minor structural knee damage, greater knee range of motion, and greater quadriceps femoris muscle strength. CONCLUSIONS: The Serbian version of the LEFS is feasible, valid, and reliable for use in both clinical practice and clinical studies to assess self-reported physical functioning in older individuals with knee osteoarthritis.

Student stress and worry related to distance education during the COVID-19 pandemic.

INTRODUCTION: The Coronavirus Disease 2019 (COVID-19) pandemic has caused considerable stress and anxiety in the general population, especially among students. The objective of this study was to determine the stress and anxiety levels among medical rehabilitation students induced by distance education during the COVID-19 pandemic. METHODOLOGY: The sample for this prospective cross-sectional study included 96 students pursuing the medical rehabilitation undergraduate degree at the Faculty of Medicine, University of Novi Sad, Serbia. All respondents took part in an online survey created on the Google Forms platform and accessed via the Facebook social network. The questionnaire included a sociodemographic section, the perceived stress scale (PSS), and the worry about online learning scale (WOLS). All data were analyzed using the IBM SPSS version 25. RESULTS: The study involved 96 students with an average age of 21.97 ± 1.55 years, 72.9% of whom were female. The total stress reported by the students during the COVID-19 pandemic was higher in females than in males (21.75 [SD = 7.50] vs. 17.84 [SD = 8.58]; p < 0.05). Younger students were more susceptible to experiencing stress during the pandemic (rho = -0.217, p < 0.05). Moreover, 57.3% of students suffered from moderate stress, while the WOLS scores indicated that distance education induced a high level of discomfort in this cohort (3.8 [IQR = 1.6]). CONCLUSIONS: Medical rehabilitation students showed a moderate level of stress and a high level of concern about distance education. This stress was more prevalent among younger students and females.

Early Menopause and Risk of Fractures-A Preventable Gap.

Background: Osteoporosis is a chronic disease that results in microarchitectural changes to the bone, thereby reducing its density and increasing the risk of fractures. This retrospective cross-sectional study aimed to examine the link between the risk of major osteoporotic fractures and hip fractures with the age of menopause onset, as well as the impact of menopause duration on fracture incidence. Methods: This retrospective cross-sectional study was conducted at the Special Hospital for Rheumatic Diseases, Novi Sad, Serbia. The data required for meeting the study objectives were obtained from patients' medical records spanning the 2015-2018 period. The sample for the study comprised of 985 postmenopausal women aged ≥ 50 yr who underwent bone mineral densitometry examination and received a FRAX score for major osteoporotic fractures and hip fractures with and without bone mineral density. The obtained FRAX scores were compared across the subjects with respect to the age of menopause onset and menopause duration. Results: The group that entered into menopause before the age of 45 had a high risk of hip fracture (OR: 1,652; 95% CI: 1,138 - 2,399; P<.01) and a higher mean FRAX score for hip fracture compared to women in whom menopause started after the age of 45 (Me=1.60 vs. 1.30, P<.004). FRAX scores were also correlated with menopause duration, and the difference between the groups with the longest (over 20 yr) and the shortest (1-10 yr) duration was statistically significant at P<.001. Conclusion: As menopause duration could contribute to the prediction of fracture risk, its inclusion in the FRAX algorithm should be considered, while also taking into account the age of menopause onset.

Risk factors for neck pain-induced disability among primary healthcare workers: A pilot study.

BACKGROUND: Neck pain (NP) is associated with high disability rates among healthcare workers. OBJECTIVE: To determine the potential risk factors associated with disability due to NP among healthcare staff working in primary care settings. METHODS: This 30-day prospective cross-sectional study involved a survey of 63 healthcare personnel (55 women and 8 men aged 45.30±12.34 years) of two primary healthcare centers in Serbia, who completed a general questionnaire developed for this purpose along with the Neck Disability Index (NDI), whereby the potential predictors of NP-related disability were assessed using the statistical package SPSS ver. 24. RESULTS: Female healthcare workers achieved a higher score on the NDI scale (Me = 8.00, p < 0.05), as did older respondents (r = 0.260, p < 0.05), those with longer work experience (r = 0.323, p < 0.05), and those that wear prescription glasses (Me = 9.00, p < 0.01). Higher NDI scores were also achieved by respondents that suffered from neck pain at the time of the study (Me = 12.50, p < 0.001), especially if they relied on pain medication (Me = 13.00, p < 0.05), and topical analgesic creams (Me = 12.50, p < 0.05) for treating neck pain. CONCLUSION: Female sex, older age, greater work experience, current neck pain, use of pain-relieving medications and creams, and need for prescription glasses to correct vision increase the risk of disability due to pain in the cervical spine among healthcare workers.

Changes in Bone Metabolism in Patients with Rheumatoid Arthritis during Tumor Necrosis Factor Inhibitor Therapy.

Tumor necrosis factor alpha (TNF-α), which enhances osteoclast activity and bone resorption, is one of the key inflammation mediators in rheumatoid arthritis (RA). The aim of this study was to assess the influence of yearlong TNF-α inhibitor application on bone metabolism. The study sample comprised 50 female patients with RA. Analyses involved the osteodensitometry measurements obtained using a "Lunar" type apparatus and the following biochemical markers from serum: procollagen type 1 N-terminal propeptide (P1NP), beta crosslaps C-terminal telopeptide of collagen type I (b-CTX) by ECLIA method, total and ionized calcium, phosphorus, alkaline phosphatase, parathyroid hormone and vitamin D. Analyses revealed changes in bone mineral density (BMD) at L1-L4 and the femoral neck, with the difference in mean BMD (g/cm2) not exceeding the threshold of statistical significance (p = 0.180; p = 0.502). Upon completion of 12-month therapy, a significant increase (p < 0.001) in P1NP was observed relative to b-CTX, with mean total calcium and phosphorus values following a decreasing trend, while vitamin D levels increased. These results suggest that yearlong application of TNF inhibitors has the capacity to positively impact bone metabolism, as indicated by an increase in bone-forming markers and relatively stable BMD (g/cm2).

The Applicability of Provocative Functional Tests in the Diagnosis of Rotator Cuff Muscle Injuries of the Best University Athletes.

Rotator cuff disease, external and internal impingement syndromes, low shoulder stability, various types of trauma, and overuse injuries are all related to sports activities. In order to check symptoms in patients with disability and shoulder pain, clinicians use different methods and diagnostic imaging assessment. The research is aimed at evaluating whether there is a difference between provocation function tests (PFT) and ultrasonographic (US) testing of muscles within the rotator cuff in elite collegiate athletes. Patients (n = 184) were recruited from university team sports selections and tested with a standardized US examination of the shoulder and five PFTs (Speed's test, Neer's test, Hawkins test, lift-off test, Yergason's test). Based on the VAS pain assessment scale, 60 subjects had some pain, which was taken for further processing in the work (124 subjects did not have the presence of pain and were excluded from further processing). The US examination was conducted using Voluson 730 apparatus, by a linear probe, with the frequency in the range of 6-12 MHz. The chi-square test showed significant differences between PFT and the occurrence of shoulder muscle tendinitis for the following variables: Speed's test and subscapularis tendinitis (p = 0.02) and Speed's test and infraspinatus tendinitis (p = 0.01); Neer test and biceps brachii caput longum tendinitis (p = 0.01), Neer test and supraspinatus tendinitis (p = 0.02) and Neer test and infraspinatus tendinitis (p = 0.01); lift-off test and subscapularis tendinitis (p = 0.05); and Yergason's test and biceps brachii caput longum tendinitis (p = 0.03) and Yergason's test and subscapitis tendinitis (p = 0.01). The greatest effect of differences was observed in Neer's test and biceps brachii caput longum tendinitis (φ = 0.60), while the other effects can be described as medium and small in most cases. It can be concluded that functional tests are good predictors of soft tissue changes in the muscles of the rotator cuff of the shoulder. Further monitoring and analysis are needed on a larger number of athletes.

Management of musculoskeletal pain in patients with idiopathic pulmonary fibrosis: a review.

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fibrotic, and fatal interstitial lung disease (ILD) of unknown etiology that primarily affects the elderly. Patients with IPF suffer from a heavy symptom burden and usually have a poor quality of life. Dyspnea and dry cough are predominant symptoms of IPF. Although pain is not considered one of the main symptoms of IPF, it can occur for a variety of reasons, such as hypoxia, coughing, muscle and nerve damage, deconditioning, and steroid use. The prevalence of pain in IPF patients varies greatly, ranging from around 30 to 80%, with the prevalence being estimated mostly among patients in the end-of-life period. It manifests itself in the form of muscle pain, joint discomfort, or back and chest pain. Approaches to the treatment of chronic musculoskeletal pain in patients with IPF include pharmacological and non-pharmacological measures that are also important to optimize the treatment of other symptoms (dyspnea and cough) and the optimal treatment of comorbidities. Given the scarcity of data on this symptom in the literature, this article summarizes what is currently known about the etiology and treatment of musculoskeletal pain in IPF.

Association Between Metabolic Syndrome, Its Components, and Knee Osteoarthritis in Premenopausal and Menopausal Women: A Pilot Study.

OBJECTIVE: This pilot study aimed to determine the correlation of metabolic syndrome (MetS), its components, and increased LDL (low-density lipoprotein) and total cholesterol levels with osteoarthritis (OA). In addition, our goal was to establish the association between MetS and the degree of handicap measured by the Lequesne index of functionality and severity of knee osteoarthritis. MATERIALS AND METHODS: The pilot study included 25 subjects with knee OA and 19 subjects without knee OA. All subjects were menopausal or premenopausal women. MetS was diagnosed according to the National Cholesterol Education Program, Adult Treatment Panel III. OA was diagnosed if Kellgren-Lawrence ≥ 2. RESULTS: MetS was detected in 80% of subjects with OA. In the non-OA group, MetS was detected in 26% of subjects. The difference in MetS prevalence between the two groups was significant (p=0.000). The presence of each MetS component was significant in the OA group, except for central obesity, which presence was marginally significant (p=0.054). Prevalence of increased total (p=0.019) and LDL cholesterol (p=0.000) was also significant in the OA group. A significant difference between OA and the non-OA group was detected in the prevalence of all five MetS components (p=0.016). In the OA group, the Lequesne index of functionality and severity of knee osteoarthritis was not significantly altered between subjects with and without MetS. CONCLUSION: Metabolic syndrome, its components, increased LDL, and total cholesterol are correlated with osteoarthritis in premenopausal and menopausal women. MetS is not correlated with the degree of handicap in the knee joint measured by the Lequesne index.

GLUCOSAMINE SULFATE EFFICACY IN TREATING KNEE OSTEOARTHRITIS: A FOLLOW-UP STUDY.

Osteoarthritis (OA) can be treated using either a pharmacological or non-pharmacological approach, or a combination of both. The purpose of the present study was to investigate the efficacy of crystalline glucosamine sulfate (CGS) in patients with knee OA. This open-label prospective study (with a 12-month follow-up) included 111 patients of both genders suffering from knee OA, who attended the Special Hospital for Rheumatic Diseases in Novi Sad, Serbia during the 2011-2013 period. Patients were divided into the experimental (n=52) and the control (n=59) group. While the former was prescribed CGS 1500 mg/day, the latter was treated with nonsteroidal anti-inflammatory drugs (NSAIDs) according to the standard protocol. The efficacy of both treatment modes was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Lequesne index, along with the radiological findings which involved knee joint space width (JSW) measurements. One year following the initial assessment, all patients reported pain intensity reduction; however, those in the CGS group experienced significantly lower pain intensity when compared with controls. At the end of the study, no reduction in the progression of joint structure damage (p>0.5) was noted in either group. Thus, while CGS demonstrated symptomatic efficacy, it failed to delay the progression of knee OA.

Potential risk factors for back pain in children.

OBJECTIVES: Back pain often develops in early childhood and becomes more frequent during adolescence. The aim of this study was to determine potential risk factors and the therapy effects on back pain in children. METHODS: This retrospective study included 96 boys and girls treated for back pain in outpatient and hospital setting in the 1.1.2016-31.12.2016 period at the Institute of Child and Youth Health Care of Vojvodina, Serbia. The influence of sex, age, physical activity and presence of concomitant locomotor system deformities, as well as applied therapies, on the back pain in children was analyzed using SPSS ver. 21. RESULTS: The studied sample comprised of 56.3% girls. The average age of the subjects was 14.64 years, 43 (44.8%) of the children were physically active. In children suffering from back pain, spinal column deformities were also noted, mostly scoliosis (27.1%) and kyphosis (20.8%). Chronic pain was diagnosed in 54 children (56.3%). The average pain intensity, as measured on the VAS, was 5.72 and 0.92 before and after therapy, respectively (p< 0.05). CONCLUSION: Among the analyzed parameters, only lumboishialgia was a significant factor in the onset of back pain, which declined following ergonomic education and physical therapy.

Capture the vertebral fracture: Risk factors as a prediction.

OBJECTIVE: Vertebral fractures are the most common osteoporotic fractures occurring due to low bone mineral density, as well as other risk factors. The aim of the paper is to investigate risk factors for vertebral osteoporotic fracture occurrence in postmenopausal women. METHODS: Retrospective analysis of data pertaining to 651 postmenopausal women obtained from the National Osteoporosis Registry of Serbia was conducted. Further analyses were performed on 217 osteoporotic women identified from those records, whereby those in the experimental group (n= 110) had a vertebral fracture, while those assigned to the control group (n= 107) did not. The two groups were comparable in terms of age (t= 0.450; p> 0.01). Risk factors that could serve as the best predictors of vertebral fracture occurrence were investigated. Multivariate logistic regression analysis was used for testing effect of several factors on vertebral fracture occurrence as the dependent variable. RESULTS: Patients that have never suffered a vertebral fracture had a significantly higher bone mineral density (t= 8.161; p< 0.01) in comparison to those with a verified vertebral fracture. Factors that significantly contributed to the risk of vertebral fracture were presence of kyphosis (OR 708.338; 95% CI 19.238-26.081.950), use of glucocorticoids (OR 87.618; 95% CI 9.175-836.707), and presence of comorbidities (OR 7.327; 95% CI 1.500-35.793). Moreover, a unit increase in body mass index (BMI) was found to lower the probability of vertebral fracture by a factor of 0.846. Women that entered menopause later have lower chance of suffering a vertebral fracture (OR = 0.539; 95% CI 0.400-0.726). CONCLUSION: Lower body mass index, presence of kyphosis, use of glucocorticoids, early menopause onset, and presence of comorbidities are the factors that contribute the most to vertebral osteoporotic fracture occurrence.

Effects of group exercise on functional abilities: Differences between physically active and physically inactive women.

BACKGROUND: Aerobic exercises to music can have a positive effect on functional and motor skills of an exerciser, their health, as well as an aesthetic and socio-psychological component. OBJECTIVE: The objective of this study was to determine the effects of reactive exercising in a group on functional capabilities in physically active and physically inactive women. METHODS: A prospective study included 64 healthy women aged 40-60 years. The sample was divided into the experimental group (N= 36), i.e. physically active women who have been engaged in recreational group exercises at the Faculty of Sport and Physical Education, University of Novi Sad, Serbia, and the control group (N= 28), which consisted of physically inactive women. All the participants were monitored using the same protocol before and after the implementation of the research. All women had their height, weight and body mass index measured as well as their spiroergometric parameters determined according to the Bruce protocol. RESULTS: A univariate analysis of variance has shown that there is a statistically significant difference between the experimental group and the control group in maximum speed, the total duration of the test, relative oxygen consumption, absolute oxygen consumption and ventilation during the final measurement. After the training intervention, the experimental group showed improvements in all the parameters analyzed compared with pretest values. CONCLUSION: The recreational group exercise model significantly improves aerobic capacity and functioning of the cardiovascular system. Therefore, it is essential for women to be involved more in any form of recreational group exercising in order to improve functional capacity and health.

Cross-cultural validation of the Modified Falls Efficacy Scale in Serbian community-dwelling women at risk for osteoporotic fracture.

OBJECTIVE: Cross-cultural validation of the Serbian version of the Modified Falls Efficacy Scale (MFES). METHODS: This cross-sectional study involved 257 women aged 65 years and above who were referred for dual-energy x-ray absorptiometry examination at the Railway Healthcare Institute in Belgrade, Serbia, between January and April 2016. Data collection comprised of a sociodemographic questionnaire and Geriatric Depression Scale-Short Form (GDS-SF) questionnaire, and data related to fractures, level of physical activity, use of medications that can increase the risk of falls, and frequency of falls in the past 12 months. None of the study participants had been previously treated for osteoporosis. The internal consistency of the questionnaire items was assessed via Cronbach's alpha, whereas the interclass correlation coefficient (ICC) was used to calculate test-retest reliability based on the sample of 257 women. We also evaluated concurrent, convergent, and construct validity. RESULTS: Cronbach's alpha for the total assay score was 0.98. Correlations among the items ranged from 0.84 to 0.93. While ICC for the scale as a whole was 0.99 (95% confidence interval 0.98-0.99), ICC pertaining to individual items ranged from 0.82 to 0.99. Concurrent validity analysis revealed a significant positive correlation between MFES scores and the reported level of physical activity (ρ = 0.34; P < 0.01). Convergent validity was tested through the ratio of MFES and sociodemographic variables. The findings indicated presence of a significant negative correlation between the MFES scores and age (ρ = -0.32; P < 0.01), age of menopause onset (ρ = -0.16; P = 0.01), and GDS-SF scores (ρ = -0.12; P = 0.04), and positive correlation between MFES and the level of social activity (ρ = 0.22; P < 0.01). Significant differences were noted between the MFES scores of participants who had no history fractures and those who did (U = 5277.50; P < 0.01), and between scores of women who reported falling in the past 12 months and those who did not (U = 4968.50; P < 0.01). Similarly, significant differences (P < 0.01) in the scores pertaining to each MFES item were observed between women who had experienced falls in the past (n = 101) and those who had not (n = 156). CONCLUSION: The Serbian version of the MFES is a reliable and valid instrument that can be used in both clinical practice and research to describe and measure self-perceived fear of falling in older individuals.